Unmet needs in VVA

Abstract

Vulvo-vaginal atrophy, also called atrophic vaginitis, is a chronic, progressive condition that results from the decrease in oestrogen levels in the vagina that commonly occurs after the menopause. Symptoms include vaginal dryness, dyspareunia, vulval and vaginal irritation and itching, soreness, vaginal discharge, post-coital bleeding, etc. [ [1] MacBride M.B. Rhodes D.J. Shuster L.T. Vulvovaginal atrophy. Mayo Clin Proc. 2010; 85: 87-94 Abstract Full Text Full Text PDF PubMed Scopus (334) Google Scholar ]. It is estimated that between 69% [ [2] Gass M.L.S. Cochrane B.B. Larson J.C. et al. Patterns and predictors of sexual activity among women in the Hormone Therapy trials of the Women's Health Initiative. Menopause. 2011; 18: 1160-1171 Crossref PubMed Scopus (67) Google Scholar ] and 98% [ [3] Freedman M.A. Vaginal pH, estrogen and genital atrophy. Menopause Manage. 2009; 17: 9-13 Google Scholar ] of postmenopausal women have signs of vaginal atrophy, with worsening features with increasing age after the menopause. In cross sectional surveys, around 50% of postmenopausal women complain of symptoms of vaginal discomfort attributable to VVA [ [4] Nappi R.E. Palacios S. Impact of vulvovaginal atrophy on sexual health and quality of life at postmenopause. Climacteric. 2014; 17: 3-9 Crossref PubMed Scopus (170) Google Scholar ]. VVA has a significant impact on the personal and sexual lives of women and their partners. Vaginal discomfort had a negative impact on many aspects of women's self-esteem and emotional well-being [ [5] Nappi R.E. Mattsson L.Å. Lachowsky M. Maamari R. Giraldi A. The CLOSER survey: impact of postmenopausal vaginal discomfort on relationships between women and their partners in Northern and Southern Europe. Maturitas. 2013; 75: 373-379 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar ]. 75% of postmenopausal women surveyed admitted it had a negative impact on quality of life [ [6] Nappi R.E. Kokot-Kierepa M. Vaginal Health: Insights, Views & Attitudes (VIVA) – results from an international survey. Climacteric. 2012; 15: 36-44 Crossref PubMed Scopus (254) Google Scholar ] and relationships with more than 70% of men noting that their partner avoided sexual intimacy because of vaginal discomfort. Despite the impact on quality of life and relationships, the fact that 62% of women complain of moderate or severe symptoms and 55% had the symptoms for 3 or more years, vulvar and vaginal atrophy remain an underreported, underdiagnosed and therefore also an undertreated condition [ [7] Parish S.J. Nappi R.E. Krychman M.L. et al. Impact of vulvovaginal health on postmenopausal women: a review of surveys on symptoms of vulvovaginal atrophy. Int J Womens Health. 2013; 5: 437-447 Crossref PubMed Scopus (141) Google Scholar ] for a number of different reasons.